Intramyocardial Dissecting Hematoma in Patients with Ischemic Cardiomyopathy: Role of Multimodality Imaging in Three Patients Treated Conservatively

Published on Aug 1, 2017in CASE
· DOI :10.1016/J.CASE.2017.05.004
Aslannif Roslan2
Estimated H-index: 2
(NIH: National Institutes of Health),
Ahmad Tantawi Jauhari Aktifanus2
Estimated H-index: 2
(NIH: National Institutes of Health)
+ 2 AuthorsAhmad Khairuddin1
Estimated H-index: 1
(NIH: National Institutes of Health)
Sources
Abstract
Intramyocardial dissecting hematoma (IDH) is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction (MI) or during the remodeling process. It is usually caused by a hemorrhagic dissection through the myocardium.1, 2 It consists of blood infiltration into and through the myocardial wall, which maintains endocardial and epicardial integrity. Formation of IDH may result from rupture of intramyocardial vessels into the interstitial space, decreased tensile strength of the infarcted area, and acute increase of coronary capillary perfusion pressure.3, 4 Before the advent of noninvasive imaging techniques, the diagnosis of IDH was made only by necropsy. It can develop in the left ventricular (LV) free wall, the right ventricle, or the interventricular septum.5 We describe three cases, focusing on the utility of echocardiography and the use of other noninvasive imaging modalities. All of our patients were treated conservatively.
References9
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#1Constantina Aggeli (UoA: National and Kapodistrian University of Athens)H-Index: 11
Last. Christodoulos StefanadisH-Index: 118
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: Intramyocardial dissecting haematoma is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction or during the remodelling process. It is usually caused by a haemorrhagic dissection among the spiral myocardial fibres and needs urgent surgical treatment. Here we report the case of a 67-year-old man with indications of a previous infarction, in whom a dissecting intramyocardial haematoma was identified using contrast echocardiography.
9 Citations
#1Vasco DiasH-Index: 6
#2Sofia CabralH-Index: 8
Last. Severo TorresH-Index: 10
view all 9 authors...
Intramyocardial dissecting haematoma (IDH) is a rare complication of myocardial infarction, with very scarce reports in medical literature. Before the advent of non-invasive imaging techniques, the diagnosis of IDH was only made by necropsy. It can develop in the left ventricular free wall, the right ventricle, or the interventricular septum. We present a case of a patient with an IDH after acute anterolateral myocardial infarction, focusing on the utility of echocardiography in the diagnosis an...
27 CitationsSource
Background: In large necropsy studies dissecting intramyocardial hematoma (DIH) with serpiginous tracts across the myocardial fibers has been reported in both the septum and the left ventricle free wall. Methods: We studied 15 patients admitted to the hospital with acute myocardial infarction (AMI) in which DIH was demonstrated by either transthoracic and/or transesophageal and confirmed intraoperatively or by necropsy. Results: In nine patients the hemorrhagic dissection was predominantly in th...
41 CitationsSource
#1Ralph Slepian (Cornell University)H-Index: 4
#2Arash SalemiH-Index: 17
Last. Nikolaos J. SkubasH-Index: 20
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#1David Harpaz (Wolfson Medical Center)H-Index: 10
#1David Harpaz (Wolfson Medical Center)H-Index: 8
Last. Yoseph RozenmanH-Index: 20
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Abstract This report describes an unusual course of rupture of the left ventricular free wall, complicating acute myocardial infarction. Spontaneous sealing of the rupture site enabled close echocardiographic follow-up, during which we monitored the development of intramyocardial dissecting hematoma and, finally, development of a full tear in the left ventricular free wall, leading to the formation of a pseudoaneurysm. The pathophysiology, management, and diagnostic criteria of these processes a...
41 CitationsSource
#1Daniele MaselliH-Index: 20
#2Ezio MicalizziH-Index: 8
Last. Carlo De GasperisH-Index: 3
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Abstract A left ventricular aneurysm can develop in patients sustaining blunt chest injury. This condition has been attributed to myocardial contusion or to a direct vascular lesion leading to myocardial necrosis. We report the case of a pseudoaneurysm resulting from myocardial dissection beginning from a small tear in the endocardial wall. Successful surgical exclusion of the pseudoaneurysm by endoaneurysmal patch closure of the communications between the aneurysm and the left ventricular cavit...
42 CitationsSource
#1Akio NakataH-Index: 5
#2Satoshi HirotaH-Index: 5
Last. Eisuke TakazakuraH-Index: 13
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We observed an unusual case of interventricular septal wall dissection in a patient with a prior myocardial infarction. Echocardiography, magnetic resonance imaging, and left ventriculography revealed separation of the right-side and left-side walls of the interventricular septum with an accessory chamber between the two walls. Morphologic findings were consistent with interventricular septal dissection.(Internal Medicine 35: 33-35, 1996)
17 CitationsSource
#1Michael B. Pliam M.D. (Eisenhower Medical Center)H-Index: 1
#2Jack J. Sternlieb (Eisenhower Medical Center)H-Index: 7
Abstract Intramyocardial dissecting hematoma following myocardial infarction is an unusual form of subacute cardiac rupture that tends to develop along naturally occurring dissection planes between the spiral muscles of the ventricle. The diagnosis has commonly been made at surgery, postmortem examination, or by echocardiography. Most are associated with acute transmural inferior infarction. Few patients survive without surgical intervention. Fourteen cases have appeared in the literature. One a...
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#1Jagdish C. MohanH-Index: 17
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Last. Sudershan K. KhannaH-Index: 2
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Background Intramyocardial dissecting haematoma is a rare and potentially life-threatening complication of myocardial infarction (MI). Only a few isolated cases have been reported so far. Case summary We report the case of a patient with a large, obstructing intramyocardial haematoma of the ventricular septum following MI due to plaque rupture of the right coronary artery (RCA) and following successful coronary intervention. The clinically inapparent haematoma was discovered during routine echoc...
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#1S. CharfeddineH-Index: 3
#2Wiem FekiH-Index: 4
Last. E. DaoudH-Index: 3
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Intramyocardial dissecting hematoma (IDH) is a rare complication of myocardial infarction (MI). It can affect the left ventricular free wall, the right ventricle, or the interventricular septum. We report a case of a 58-year-old man with an IDH following an acute anterior wall myocardial infarction detected by echocardiography and confirmed by Cardiac magnetic resonance (CMR).
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Last. Avery Tung (U of C: University of Chicago)H-Index: 27
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Abstract Intramyocardial hematomas are a rare complication of myocardial infarctions. Normally restricted to the left ventricle, in certain scenarios such as after a percutaneous coronary intervention, intramyocardial hematomas can occur in the left atrium as well. We describe the case of a 74 year old male who presented to our institution with a large inferior wall MI, refractory to multiple pressor therapy, thus requiring VA ECMO support. Through the course of his hospital stay, the patient de...
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#1Chayakrit Krittanawong (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 14
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To review the epidemiology, pathogenesis, diagnosis using emerging imaging modalities, management strategy, and prevention of recurrent spontaneous coronary artery dissection (SCAD) and provide a more extensive review of the current data. SCAD generally affects women without conventional cardiovascular risk factors. Diagnosis and management of SCAD are challenging due to heterogeneity, undefined mechanisms, differing phenotypes, and a lack of strong clinical evidence. After reviewing the current...
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#1Amal A. Sakrana (Mansoura University)H-Index: 3
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Intramyocardial dissecting hematoma (IMDH) is an uncommon fatal complication after acute myocardial infarction. It is usually under identified. Transthoracic echocardiography is the first-line moda...
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#1Jan Hrudka (Charles University in Prague)H-Index: 3
Abstract Intramyocardial dissection or intramyocardial dissecting hematoma (IDH) is uncommon complication either of myocardial infarction or severe thoracic injury. IDH is caused by intersecting bleeding between the layers of myocardial fibers. In contrast to cardiac rupture, the myocardial wall maintains its integrity. In this paper we present a case of patient suffering with ischemic heart disease, reporting worsening chest pain and dyspnea 2 months after autovenous graft bypass surgery. The c...
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#1Tjen Jhung Lee (NIH: National Institutes of Health)H-Index: 1
#2Aslannif Roslan (NIH: National Institutes of Health)H-Index: 2
Last. Azmee Mohd Ghazi (NIH: National Institutes of Health)H-Index: 3
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BACKGROUND: Intramyocardial dissecting haematoma is a rare complication of myocardial infarction (MI) associated with high mortality rates. Studies and research of this occurrence are limited largely to isolated case reports or case series. CASE SUMMARY: We report a case of late presenting MI, where on initial echocardiogram had what was thought to be an intraventricular clot. However, upon further evaluation, the patient actually had an intramyocardial haematoma, with the supporting echocardiog...
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